Segmental Premaxillary Bowl Cutting as an Alternative PNAM Approach for Extreme Premaxillary Rotation in Bilateral Cleft Lip and Palate Case Series

ObjectiveTo evaluate the feasibility of a modified presurgical naso-alveolar molding (PNAM) technique using segmental bowl cutting with contralateral soft-liner augmentation for correcting severely rotated premaxillae in infants with bilateral cleft lip and palate (BCLP).DesignProspective case series.SettingClinical case series conducted over a 2-year period (July 2022-July 2024) at a single center.ParticipantsThree infants diagnosed with BCLP presenting with extreme premaxillary rotation (2 rightward, 1 leftward).ResultsAll 3 premaxillae achieved the predefined midline criterion within 4 to 5 weeks (28-35 days) at an average correction rate of approximately 2 mm per week. No major complications were observed; mild transient mucosal blanching was noted in 2 infants, which resolved with appliance relief.ConclusionsSegmental cutting of the PNAM bowl with contralateral soft-liner augmentation appears to be a feasible and clinically useful adjunct for correcting severely rotated premaxillae prior to labioplasty. These preliminary findings require validation in larger, controlled studies before superiority over conventional PNAM can be established.